This study examined the association between levels of bisphenol A (BPA) in urine and diabetes. The study used data from the National Health and Nutritional Examination Survey from 2003-2008. Higher levels of urinary BPA were associated with increased odds of diabetes, even after adjusting for factors like age, gender, BMI and cholesterol levels. Compared to the lowest quartile of BPA, the highest quartile was associated with 68% higher odds of diabetes. The association was seen in both normal weight and overweight/obese individuals. This study suggests BPA exposure may play a role in diabetes risk.
ABSTRACT- Background: Obesity is rising in medical students due to their stressful academic calendar and sparse time for sports. Obesity is aggravated by the regular drinking of alcohol, a recreational and stress-busting activity, particularly for the male students. Obesity leads to insulin resistance. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) >2 has been reported to independently predict cardiovascular risk. Although many studies are there on obesity of medical students, few studies exist in Central India on the prevalence of insulin resistance in medical students. Therefore, prevalence of insulin resistance and its association with obesity and alcoholism was investigated in the first year male medical students of LN Medical College, Bhopal, India.
Methods: 50 male medical students of first year were investigated and considered overweight/obese if BMI>=23 or centrally obese if waist circumference (WC)>=90cm. Alcohol intake of more than 20gm per day was considered as high alcohol intake. HOMA-IR was calculated from fasting glucose and fasting insulin, whereas HOMA-IR>=2 was regarded as high.
Results: Insulin resistance measured by HOMA-IR>=2 was found in 40%, central obesity as per waist circumference in 20%, overall obesity/overweight as per BMI in 60% and alcoholism in 42%. Significant association was found between insulin resistance and central obesity measured by waist circumference (p value 0.001), but not with BMI and alcoholism. Conclusion: Prevalence of insulin resistance in first year male medical students was high and insulin resistance was significantly associated with central obesity.
Key-words- BMI, Waist circumference, HOMA-IR, Insulin resistance, Alcoholism
Because of such a high consumption level, any risky impact of these pills on public health would be important. The present study aimed to determine the relationship between consumption of OCPs and hypertension. Method: In this retrospective, cross-sectional study, 165women below 40 years of age who used OCPs were selected by convenience sampling. Necessary information was obtained by a checklist containing demographic information, obstetric history, and OCPs use history based on the subjects’ medical records. Besides, blood pressure and weight were measured at the beginning of OCPs consumption as well as 6 months and one year after that. Results: The results showed a significant difference between the subjects’ mean systolic blood pressure one year after OCPs consumption compared to the beginning (P=0.03). Moreover, this difference was related to the type of pills, such a way that it was significant in the patients who took Low Dose (LD) OCPs compared to those who used Triphasic pills (P=0.01). Conclusion: Consuming the currently available OCPs that contain lower estrogen content had an insignificant effect on blood pressure. However, it is recommended to take care of blood pressure in order to identify the unique occasional responses.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
ABSTRACT- Background: Obesity is rising in medical students due to their stressful academic calendar and sparse time for sports. Obesity is aggravated by the regular drinking of alcohol, a recreational and stress-busting activity, particularly for the male students. Obesity leads to insulin resistance. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) >2 has been reported to independently predict cardiovascular risk. Although many studies are there on obesity of medical students, few studies exist in Central India on the prevalence of insulin resistance in medical students. Therefore, prevalence of insulin resistance and its association with obesity and alcoholism was investigated in the first year male medical students of LN Medical College, Bhopal, India.
Methods: 50 male medical students of first year were investigated and considered overweight/obese if BMI>=23 or centrally obese if waist circumference (WC)>=90cm. Alcohol intake of more than 20gm per day was considered as high alcohol intake. HOMA-IR was calculated from fasting glucose and fasting insulin, whereas HOMA-IR>=2 was regarded as high.
Results: Insulin resistance measured by HOMA-IR>=2 was found in 40%, central obesity as per waist circumference in 20%, overall obesity/overweight as per BMI in 60% and alcoholism in 42%. Significant association was found between insulin resistance and central obesity measured by waist circumference (p value 0.001), but not with BMI and alcoholism. Conclusion: Prevalence of insulin resistance in first year male medical students was high and insulin resistance was significantly associated with central obesity.
Key-words- BMI, Waist circumference, HOMA-IR, Insulin resistance, Alcoholism
Because of such a high consumption level, any risky impact of these pills on public health would be important. The present study aimed to determine the relationship between consumption of OCPs and hypertension. Method: In this retrospective, cross-sectional study, 165women below 40 years of age who used OCPs were selected by convenience sampling. Necessary information was obtained by a checklist containing demographic information, obstetric history, and OCPs use history based on the subjects’ medical records. Besides, blood pressure and weight were measured at the beginning of OCPs consumption as well as 6 months and one year after that. Results: The results showed a significant difference between the subjects’ mean systolic blood pressure one year after OCPs consumption compared to the beginning (P=0.03). Moreover, this difference was related to the type of pills, such a way that it was significant in the patients who took Low Dose (LD) OCPs compared to those who used Triphasic pills (P=0.01). Conclusion: Consuming the currently available OCPs that contain lower estrogen content had an insignificant effect on blood pressure. However, it is recommended to take care of blood pressure in order to identify the unique occasional responses.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
Journal of Schizophrenia Research is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of a mental disorder often characterized by abnormal social behavior and failure to recognize what is real with common symptoms including false beliefs, auditory hallucinations, confused or unclear thinking, inactivity, and reduced social engagement and emotional expression. The journal focuses upon the latest research in finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and treatment of schizophrenia.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Journal of Schizophrenia Research accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of schizophrenia including, finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and its treatment.
Serum Total Bilirubin levels in Diabetic Retinopathy - A case control studyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Prospective Cohort Study for Cardiovascular Intervention Medical research- Pu...Pubrica
Cohort studies are the analytical design of observational studies that are epidemiologically used to identify and quantify the relationship between exposure and outcome
This article will provide knowledge about Designing A Prospective Cohort Study For Cardiovascular Intervention
Learn More: https://bit.ly/2NOP5ZX
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
Prevalence of Gall Stone Disease and its Relation to Hypercholesteraemia, Hyp...Apollo Hospitals
To investigate the prevalence of gall stone disease in the affluent north Indian population and to study its
association with hypercholesteraemia, hypertension and diabetes, in isolation and together. A survey of 1000 subjects who reported to the hospital for routine health check (including physical examination, routine blood investigations and abdominal ultrasound).
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
Intake of Black Vinegar on Anthropometric Measures, Cardiometabolic Profiles,...mahendrareddychirra
Obesity and type 2 diabetes mellitus are the most important chronic diseases around the world. They are associated with huge medical expenditure and with increasing morbidity and mortality among related cardio-metabolic diseases in developing and developed countries [1,2].
Vinegar was first reported to have anti-glycemic effects since 1988 in animal and human studies [3]. Vinegar may be associated with improved insulin sensitivity and delayed gastric emptying that accompanied improved glycemic control and reduced body weight [4,5].
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
Journal of Schizophrenia Research is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of a mental disorder often characterized by abnormal social behavior and failure to recognize what is real with common symptoms including false beliefs, auditory hallucinations, confused or unclear thinking, inactivity, and reduced social engagement and emotional expression. The journal focuses upon the latest research in finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and treatment of schizophrenia.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Journal of Schizophrenia Research accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of schizophrenia including, finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and its treatment.
Serum Total Bilirubin levels in Diabetic Retinopathy - A case control studyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Prospective Cohort Study for Cardiovascular Intervention Medical research- Pu...Pubrica
Cohort studies are the analytical design of observational studies that are epidemiologically used to identify and quantify the relationship between exposure and outcome
This article will provide knowledge about Designing A Prospective Cohort Study For Cardiovascular Intervention
Learn More: https://bit.ly/2NOP5ZX
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
Prevalence of Gall Stone Disease and its Relation to Hypercholesteraemia, Hyp...Apollo Hospitals
To investigate the prevalence of gall stone disease in the affluent north Indian population and to study its
association with hypercholesteraemia, hypertension and diabetes, in isolation and together. A survey of 1000 subjects who reported to the hospital for routine health check (including physical examination, routine blood investigations and abdominal ultrasound).
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
Intake of Black Vinegar on Anthropometric Measures, Cardiometabolic Profiles,...mahendrareddychirra
Obesity and type 2 diabetes mellitus are the most important chronic diseases around the world. They are associated with huge medical expenditure and with increasing morbidity and mortality among related cardio-metabolic diseases in developing and developed countries [1,2].
Vinegar was first reported to have anti-glycemic effects since 1988 in animal and human studies [3]. Vinegar may be associated with improved insulin sensitivity and delayed gastric emptying that accompanied improved glycemic control and reduced body weight [4,5].
38 experts on bpa panel consensus statement. effects in animals and potential...ricguer
Un conjunto de 38 prestigiados científicos de todo el mundo alertan sobre el potencial nocivo y los impactos de exposición al Bisphenol A para la salud humana.
Systematic Reviews and Meta- and Pooled AnalysesEffects of.docxssuserf9c51d
Systematic Reviews and Meta- and Pooled Analyses
Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk
Factors: A Meta-Analysis of Randomized Controlled Clinical Trials
Tian Hu, Katherine T. Mills, Lu Yao, Kathryn Demanelis, Mohamed Eloustaz, William S. Yancy, Jr,
Tanika N. Kelly, Jiang He, and Lydia A. Bazzano*
* Correspondence to Dr. Lydia A. Bazzano, Department of Epidemiology, Tulane University School of Public Health and Tropical
Medicine. 1440 Canal Street, SL-18, Suite 2000, New Orleans, LA 70112 (e-mail: [email protected]).
Initially submitted December 16, 2011; accepted for publication May 11, 2012.
The effects of low-carbohydrate diets (≤45% of energy from carbohydrates) versus low-fat diets (≤30% of
energy from fat) on metabolic risk factors were compared in a meta-analysis of randomized controlled trials.
Twenty-three trials from multiple countries with a total of 2,788 participants met the predetermined eligibility crite-
ria (from January 1, 1966 to June 20, 2011) and were included in the analyses. Data abstraction was conducted
in duplicate by independent investigators. Both low-carbohydrate and low-fat diets lowered weight and improved
metabolic risk factors. Compared with participants on low-fat diets, persons on low-carbohydrate diets experi-
enced a slightly but statistically significantly lower reduction in total cholesterol (2.7 mg/dL; 95% confidence inter-
val: 0.8, 4.6), and low density lipoprotein cholesterol (3.7 mg/dL; 95% confidence interval: 1.0, 6.4), but a greater
increase in high density lipoprotein cholesterol (3.3 mg/dL; 95% confidence interval: 1.9, 4.7) and a greater de-
crease in triglycerides (−14.0 mg/dL; 95% confidence interval: −19.4, −8.7). Reductions in body weight, waist
circumference and other metabolic risk factors were not significantly different between the 2 diets. These
findings suggest that low-carbohydrate diets are at least as effective as low-fat diets at reducing weight and
improving metabolic risk factors. Low-carbohydrate diets could be recommended to obese persons with abnor-
mal metabolic risk factors for the purpose of weight loss. Studies demonstrating long-term effects of low-
carbohydrate diets on cardiovascular events were warranted.
carbohydrate-restricted diet; fat-restricted diet; meta-analysis; metabolic syndrome; obesity
Abbreviations: CI, confidence interval; HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol.
There were an estimated 937 million overweight and 396
million obese people worldwide in 2005 (1). Moreover, it
was estimated that 68.0% of American adults were either
overweight or obese in 2009 (2). Overweight and obesity
are important risk factors for diabetes, cardiovascular dis-
ease, cancer, and premature death. The high prevalence of
obesity has become a serious public health challenge. The
dietary recommendations for weight loss from the Ameri-
can Heart Association and the National Insti ...
RESEARC
H ARTICLE
& 2017 American Journal of Preventive Medicine. Pu
reserved.
From the 1D
Medical Cen
Medicine, Ba
Hypertension
Boston, Mass
Atlanta, Geo
Wellness, M
Washington
Public Healt
Winston-Sale
Center, Jack
Feinberg Sch
Address
Medicine, T
McCampbell
[email protected]
0749-3797
https://do
blished by Elsevier Inc. All r
Modifiable Lifestyle Risk Factors and Incident Diabetes
in African Americans
Joshua J. Joseph, MD,1,2 Justin B. Echouffo-Tcheugui, MD, PhD,3,4
Sameera A. Talegawkar, PhD,5 Valery S. Effoe, MD,6 Victoria Okhomina, MPH,7
Mercedes R. Carnethon, PhD,8 Willa A. Hsueh, MD,1 Sherita H. Golden, MD2
Introduction: The associations of modifiable lifestyle risk factors with incident diabetes are not well
investigated in African Americans (AAs). This study investigated the association of modifiable
lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden)
with incident diabetes among AAs.
Methods: Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson
Heart Study who were free of diabetes at baseline (2000–2004) using baseline questionnaires and
combined into risk factor categories: poor (0–3 points), average (4–7 points), and optimal (8–11
points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis,
use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson
regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI.
Outcomes were collected 2005–2012 and data analyzed in 2016.
Results: Over 7.6 years, there were 560 incident diabetes cases (mean age¼53.3 years, 64% female).
An average or optimal compared to poor risk factor categorization was associated with a 21%
(IRR¼0.79, 95% CI¼0.62, 0.99) and 31% (IRR¼0.69, 95% CI¼0.48, 1.01) lower risk of diabetes.
Among participants with BMI o30, IRRs for average or optimal compared to poor categorization
were 0.60 (95% CI¼0.40, 0.91) and 0.53 (95% CI¼0.29, 0.97) versus 0.90 (95% CI¼0.67, 1.21) and
0.83 (95% CI¼0.51, 1.34) among participants with BMI ≥30.
Conclusions: A combination of modifiable lifestyle factors are associated with a lower risk of
diabetes among AAs, particularly among those without obesity.
Am J Prev Med 2017;53(5):e165–e174. & 2017 American Journal of Preventive Medicine. Published by
Elsevier Inc. All rights reserved.
INTRODUCTION
epartment of Medicine, The Ohio State University, Wexner
ter, Columbus, Ohio; 2Johns Hopkins University, School of
ltimore, Maryland; 3Division of Endocrinology, Diabetes and
, Brigham and Women’s Hospital, Harvard Medical School,
achusetts; 4Rollins School of Public Health, Emory University,
rgia; 5Sumner M. Redstone Global Center for Prevention and
ilken Institute School of Public Health at the George
University, Washington, District of Columbia; 6Division of
h Sciences, Wake Forest University, School of Medicine,
m, North Carolina; 7Univer.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.
Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received.
Correlation between Blood group, Hypertension, Obesity, Diabetes, and combina...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Parental alcohol consumption and the risk of congenital heart diseases in off...BARRY STANLEY 2 fasd
Conclusions: Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.
Clinical, laboratory and histological associations in clinical, laboratory an...Dr. sreeremya S
Clinical, laboratory and histological associations in clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease
Background and Aims.Metabolic syndrome (MetS) is a disorder that includes a cluster
of several risk factors for the development of type 2 diabetes and cardiovascular disease.
The R230C variant of theABCA1gene has been associated with low HDL-cholesterol in
several studies, but its association with MetS in children remains to be determined. The
aim of this study was to analyze the association of the R230C variant with MetS and other
metabolic traits in school-aged Mexican children.
Methods.The study was performed in seven urban primary schools in the State of
Mexico. Four hundred thirty-two Mexican school-age children 6e13 years old were
recruited. MetS was identified using the International Diabetes Federation definition.
The R230C variant of theABCA1gene was genotyped to seek associations with MetS
and other metabolic traits.
Results.The prevalence of MetS was 29% in children aged 10e13 years. The R230C
variant was not associated with MetS (OR51.65;p50.139). Furthermore, in the whole
population, the R230C variant was associated with low HDL-cholesterol levels
(bcoefficient53.28,p!0.001). Interestingly, in the total population we found a novel
association of this variant with high triglyceride levels (b coefficient 514.34;
p50.027).
Conclusions.We found a new association of the R230C variant of the ABCA1 gene with
high triglyceride levels. Our findings also replicate the association of this variant with low
HDL-cholesterol levels in Mexican school-age children.
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
Potential Adverse Effect of Caffeine Consumption - JavaCoffeeiq.comJavaCoffeeIQ.com
a systematic review published in the journal Food and Chemical Toxicology concluded that even up to eight cups of coffee daily “is not associated with significant concern regarding the risk of fracture and fall,” especially in healthy adults who get enough calcium.
https://javacoffeeiq.com/c/side-effects-of-coffee/
Similar to Relationship between urinary Bisphenol A (BPA) levels and diabetes mellitus (20)
Respuesta a Solicitud de Estudios de Calidad de Agua, Municipio San Luis Poto...ricguer
Cuando existe "Transparencia de la Información", se puede acceder por cuaquier medio. Sin embargo, el Municipio de San Luis Potosi, obliga a que si alguien quiere conocer la información pública, se presente, con identificación y en los horarios que ellos imponen para que hagan el favor de enseñar la información pública. Esta es una aberración de la "Transparencia".
Estudios de Calidad de Agua, Municipio de Monterrey, Nuevo León 2014 Estudios...ricguer
PRIMER ATLAS DE CALIDAD DE AGUA POR COLONIA DE MEXICO : http://www.ecodomestico.com
Calidad de Agua del Municipio de Monterrey, Estado de Nuevo León, México. En este estudio se muestran exclusivamente los Análisis Fisico-químicos. No se entrega la Información por Colonia y en su lugar se entregan los Estudios por POZOS, TANQUES Y RED que existe en diversos puntos del Municipio de Monterrey. Cabe destacar, que de los 46 parámetros que indica la norma, se entregan 42 parámetros, faltando únicamente 4 parámetros, totalmente contrario a lo que entregó, por ejemplo el municipio de Toluca, en el Estado de México. Los niveles de Dureza son elevados en general. Es necesario monitorear los niveles de Cianuro, Fluoruros, Arsénico, Aluminio, Sulfatos y Sodio, ya que podrían variar y sobrepasar la norma establecida fácilmente y ser altamente peligrosos para la Salud.
Estudios de Calidad de Agua, Municipio de Monterrey, Nuevo León 2014 Cloro Re...ricguer
PRIMER ATLAS DE CALIDAD DE AGUA POR COLONIA DE MEXICO : http://www.ecodomestico.com
Calidad de Agua del Municipio de Monterrey, Estado de Nuevo León, México. En este estudio se muestran exclusivamente los Análisis de Cloro Residual. No se entrega la Información por Colonia y en su lugar se entregan los Estudios de Cloro Residual que existe en diversos puntos del Municipio de Monterrey.
Calidad de Agua del Municipio de Aguascalientes, Aguascalientes Mexico junio ...ricguer
Se solicita la Calidad de Agua del Municipio de Aguascalientes, Estado de Aguascalientes, México. NO NOS ENTREGAN LOS ESTUDIOS, pero la respuesta es que : SE CLASIFICA COMO INFORMACION RESERVADA, porque ".. su divulgamiento pondría en peligro la estabilidad Financiera del municipio...".
Según el titular, porque estan en proceso un análisis de inversión para equipamiento de los pozos.
Sin embargo, no exsite relación alguna para impedir a los ciudadanos el conocer la Calidad de Agua que distribuyen. Este "Clasificación de Información Reservada" es un claro signo que puede indicar Alertas de Corrupción en este ayuntamiento o de ocultamiento de la Información, a fin de que la población no tenga ni la mas mínima idea del probable veneno que distribuyen a los ciudadanos. En todo caso, es un raro, pero típico caso de Ocultamiento de la Información en detrimento de la población a la que dicen servir y de la cual se sirven con un inmerecido salario.
Calidad de Agua de Cancún, Municipio Benito Juárez, Quintana Roo. Mayo 2014 ...ricguer
PRIMER ATLAS DE CALIDAD DE AGUA POR COLONIA DE MEXICO : http://www.ecodomestico.com
Calidad de Agua de Cancún, dentro del Municipio de Benito Juárez, en el estado de Quintana Roo, México. Faltan 37 parámetros de medición establecidos por la Norma Oficial Mexicana de los 46 establecidos. 3 de estos solo aparecen ls encabezados. Con los Datos Proporcionados, este municipio cuenta con una de las peores Calidades de Agua de Todo el País, administrada por una compañia privada llamada AGUAKAN.
Los niveles de Nitratos se encuentran muy por encima de los niveles máximos de la norma. Los elevados niveles de Cloruros y de Solidos Disueltos Totales -SDT- (sales y residuos orgánicos) hacen que el agua sea prácticamente imbebible.En Estados Unidos, el límite máximo de SDT es de 500, mientras que en México se permiten 1000 ppm.
El nivel de Dureza (calcio y magnesio) es generalmente muy alto en la casi totalidad de las fuentes que suministran agua. La elevada dureza del agua puede generar hipercalcemia, insuficiencia renal, hipertiroidismo o cáncer de pulmón, además que las tuberías se tapan por la acumulación de calcio.
La empresa AGUAKAN presume en su página de internet el contar con el Premio Nacional de Cloración, olvidando los 45 parámetros restantes y obligatorios para proporcionar Agua Potable. En este caso NO EXISTE DIFERENCIA entre una empresa privada y una pública para entregar una Calidad de agua que sea aceptable y POTABLE.
Relación entre concentraciones de aluminio en el agua potable y el alzheimer ...ricguer
Estudio Realizado en el sudoeste de Francia en Dorgogne y Gironde en 3,777 personas iniciando en 1988 y 1989, con una duración en el seguimiento por 8 años. Se investigaron los efectos de la presencia de Aluminio en el Agua Potable y sus consecuencias : Se confirman las consecuencias de personas con Alzheimer entre mayor concentraciones de Aluminio. Se corroboran las hipótesis de varios estudios mas : Aluminio = Alzheimer http://www.ecodomestico.com
Riesgos Graves del aluminio en la salud humana frricguer
En este estudio realizado en colaboración con la AFSSA (L'Agence française de sécurité sanitaire des aliments) se puede observar a partir de la página 41, los daños y la relación del consumo de este metal con la enfermedad del Alzheimer y numerosas enfermedades mas. El evitar consumirlo, significará reducir las probabilidades de llegar a padecer esta grave enfermedad. http://www.ecodomestico.com
Calidad de Agua Municipio de tepic, estado de Nayarit, Julio 2013 INFOPLACITUMricguer
PRIMER ATLAS DE CALIDAD DE AGUA DE MEXICO : http://www.ecodomestico.com
Estudios Calidad de Agua de Tepic Nayarit. No entregan análisis de 2013 porque estos no los han realizado (ya que consideran que no es importante) o porque simplemente no desean que se sepa la calidad que proveen a los ciudadanos.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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and reported opposing findings—with one study reporting a positive association (8) and the other not
detecting an association (9). However, both of the studies (8, 9) used self-reported diabetes as the
outcome; fasting glucose or glycosylated hemoglobin was not used as a criterion in defining diabetes
in these studies as recommended by recent guidelines (10). Studies (11) have shown that, when using
self-reported diabetes as opposed to blood glucose measurements, there is likely to be substantial
misclassification of diabetes status and this may consequently lead to biased risk associations. In this
context, we examined the association between urinary BPA levels and diabetes mellitus in the 2003 to
2008 National Health and Nutritional Examination Survey (NHANES), a representative sample of
U.S. adults. In the current report we had fasting glucose levels as well as glycosylated hemoglobin to
define diabetes mellitus according to the latest American Diabetes Association guidelines.
Subjects and Methods
The current study is based on data from the NHANES 2003–2008. Detailed descriptions of NHANES
study design and methods are available elsewhere (12–14). In brief, the NHANES survey included a
stratified multistage probability sample representative of the civilian noninstitutionalized U.S.
population. Selection was based on counties, blocks, households, and individuals within households
and included the oversampling of non-Hispanic blacks and Mexican-Americans to provide stable
estimates of these groups. Subjects were required to sign a consent form before their participation,
and approval was obtained from the Human Subjects Committee of the U.S. Department of Health
and Human Services.
The current study sample consisted of participants more than 20 yr old among whom urinary BPA
was available (n = 4792). We excluded subjects with self-reported cardiovascular disease (n = 495)
and also subjects with missing data (n = 330) on covariates included in the multivariable model,
including level of education, smoking status, serum or fasting glucose levels, systolic or diastolic blood
pressure, body mass index (BMI), or cholesterol levels. This resulted in 3967 participants (51.7%
women), 467 of whom had diabetes.
Exposure measurements
Age, gender, race/ethnicity, smoking status, alcohol intake (grams per day), level of education, history
of diabetes, and oral hypoglycemic intake or insulin administration were assessed using a
questionnaire (12–14). Individuals who had not smoked more than 100 cigarettes in their lifetime
were considered never smokers; those who had smoked more than 100 cigarettes in their lifetime were
considered former smokers if they answered negatively to the question “Do you smoke now?” and
current smokers if they answered affirmatively. BMI was calculated as weight in kilograms divided by
height in meters squared.
Rigorous procedures with quality control checks were used in blood collection, and details about these
procedures are provided in the NHANES Laboratory/Medical Technologists Procedures Manual
(12–14). Seated systolic and diastolic blood pressures were measured using a mercury
sphygmomanometer according to the American Heart Association and Seventh Joint National
Committee recommendations (15). Up to three measurements were averaged for systolic and diastolic
blood pressures. Patients were considered hypertensive if they reported the current use of blood
pressure-reducing medication and/or had systolic blood pressure greater than 140 mm Hg and/or
diastolic blood pressure greater than 90 mm Hg (15). Urinary creatinine was analyzed using the Jaffe
rate reaction method and using the CX3 analyzer (Beckman Coulter, Inc., Brea, CA) (16).
Previous measures of BPA in biological matrixes involved techniques such as gas chromatography
(GC) or HPLC (17). To achieve enhanced sensitivity and selectivity over previous methods, in the
current NHANES, measures of environmental phenols were derivatized to alkyl or acyl derivatives
before GC/mass spectrometry analysis (16). Using solid-phase extraction coupled to HPLC and
tandem mass spectrometry, detection levels of 0.1–2 ng/ml in 100 µl of urine were achieved, sufficient
for measuring urinary BPA levels in non-occupationally exposed participants (16).
Main outcome of interest: diabetes
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Serum glucose was measured using the modified hexokinase method at the University of Missouri
Diabetes Diagnostic Laboratory. Diabetes mellitus was defined based on the recent guidelines of the
American Diabetes Association (10) as a serum glucose greater than 126 mg/dl after fasting for a
minimum of 8 h, a serum glucose greater than 200 mg/dl for those who fasted less than 8 h before
their NHANES visit, a glycosylated hemoglobin value greater than 6.5%, or self-reported current use
of oral hypoglycemic medication or insulin.
Statistical analysis
Urinary BPA was categorized into quartiles (<1.10, 1.10–2.10, 2.11–4.20, and >4.20 ng/ml). We
hypothesized that high BPA levels are associated with diabetes mellitus. The odds ratio (OR) [95%
confidence interval (CI)] of diabetes for BPA was calculated by taking the lowest quartile (quartile 1)
as the referent and using multivariable logistic regression models. We used two models: the age- and
sex-adjusted model and the multivariable model, additionally adjusting for race/ethnicity
(non-Hispanic whites, non-Hispanic blacks, Mexican-Americans, and others), education categories
(below high school, high school, above high school), smoking (never smoker, former smoker, current
smoker), alcohol intake (nondrinker, moderate drinker, heavy drinker), BMI (normal, overweight,
obese), systolic blood pressure, diastolic blood pressure, urinary creatinine (milligrams per deciliter),
and total serum cholesterol (milligrams per deciliter). Trends in the OR of diabetes across increasing
urinary BPA categories were determined by modeling BPA as an ordinal variable. Sample weights that
account for the unequal probabilities of selection, oversampling, and nonresponse were applied for all
analyses using SAS (version 9.2; SAS Institute, Cary, NC) and SUDAAN software; SE values were
estimated using the Taylor series linearization method.
Results
Table 1 shows the baseline characteristics of the population by gender. Smokers were found to have a
statistically nonsignificant higher mean BPA level (4.17 ± 0.29 ng/dl) when compared with
nonsmokers (3.86 ± 0.19 ng/dl) (P = 0.216). Table 2 shows the association between increasing levels
of BPA and diabetes mellitus. Overall, we observed positive association between increasing BPA levels
and diabetes in both the age- and sex-adjusted model and the multivariable-adjusted model. Models
evaluating trend in this association were also statistically significant.
Table 3 shows the association between increasing BPA levels and diabetes mellitus by BMI categories.
We found that the association between increasing BPA levels and diabetes was consistently present
among normal-weight as well as overweight/obese subjects; p-trends for the association were also
significant. In a supplementary analysis, we examined the association between BPA and diabetes
separately among smokers and nonsmokers. We found that, consistent with our main findings in
Table 2, there was a positive association between BPA and diabetes among smokers and nonsmokers;
the p-interaction for the cross-product BPA × smoking status term was 0.6530, suggesting that the
association between BPA and diabetes did not differ by smoking status.
Discussion
In a large multiethnic, nationally representative sample, we found that increasing serum BPA levels
are positively associated with diabetes mellitus. The observed association was found to be
independent of confounding factors such as BMI, urinary creatinine (18), alcohol intake, and serum
cholesterol level. Our study adds to the emerging evidence of the role of environmental exposure to
BPA on cardiometabolic health in humans.
BPA is an environmental chemical used as a constituent monomer in polycarbonate plastics, which
are used extensively in drink containers and food packaging and in the production of oxidant used in
the lining of canned goods (1). Exposure to BPA is believed to be mainly through dietary intake, with
additional exposure through water, dental sealants, inhalation of household dusts, and exposure
through skin (1). Recent studies have documented that over 90% of the U.S. general population has
measurable concentrations of BPA metabolites in urine (2, 3).
Several lines of recent evidence suggest that an association between urinary BPA levels and diabetes
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mellitus may be biologically plausible. Animal studies have shown that BPA exposure may have a role
in weight gain and obesity development through several mechanisms, including the action of BPA on
preadipocytes (19, 20), a role as an estrogen (6), potential interactions with estrogen-related receptor
γ (21), action as a thyroid hormone antagonist (4), role as a peroxisome proliferator-activated receptor
γ antagonist (22), and its role in influencing pancreatic endocrine function (23). Furthermore,
Alonso-Magdalena et al. (24) in a recent experiment showed that mice exposed to BPA levels as low
as 10 µg/kg·d developed hyperinsulinemia, insulin resistance, and glucose intolerance. Finally,
Carwile and Michels (25) showed that urinary BPA levels are associated with obesity in the NHANES
survey. Therefore, it is possible that BPA may contribute to obesity and thereby indirectly to the
development of type 2 diabetes.
However, there are few studies in humans for comparison. Two previous studies (8, 9) have examined
the association between higher BPA levels and self-reported diabetes and have reported conflicting
results; whereas one study found a positive association (8), the other did not (9). However, it is well
known that in epidemiological studies (11), self-reported diabetes largely underdiagnoses the actual
prevalence of diabetes in a population. When using self-reported diabetes, a substantial number of
people who actually have diabetes may be misclassified as normoglycemic, and such a
misclassification would likely underestimate a true association if it is present. The main advantage of
our study over the previous two studies is that we defined diabetes consistent with the latest American
Diabetes Association guidelines (10) and included fasting glucose, nonfasting glucose, and
glycosylated hemoglobin levels in addition to self-reported diabetes. Consequently, we found that
there was a positive association between serum BPA levels and diabetes mellitus in this nationally
representative sample of U.S. adults. In subsequent stratified analysis, the observed association was
found to be present among both normal-weight and overweight/obese adults.
The main strengths of our study include its nationally representative sample, use of rigorous study
methods to collect the data, and the availability of extensive data on confounders. The main study
limitation is that the current study is cross-sectional in nature, therefore making it impossible to draw
cause and effect in the observed associations. Future prospective studies are required to confirm or
disprove our findings.
In summary, we found that in a nationally representative sample of U.S. adults, higher BPA levels
were positively associated with diabetes mellitus independent of confounding factors such as age,
BMI, alcohol intake, and cholesterol levels. If confirmed in future prospective studies, reducing
environmental exposure to BPA may have a role in the prevention of diabetes mellitus.
Acknowledgments
This study was funded by an American Heart Association National Clinical Research Program grant
(to A.S.) and National Institutes of Health Grant 5R03ES018888-02 (to A.S.).
Both authors contributed to the intellectual development of this paper. A.S. had the original idea for
the study, wrote the paper, and is the guarantor. S.T. performed the statistical analyses and was
involved in critical revisions to the manuscript.
Disclosure Summary: There are no conflicts of interest related to this manuscript.
Footnotes
Abbreviations:
BMI Body mass index
BPA bisphenol A
CI confidence interval
GC gas chromatography
OR odds ratio.
References
1. Vandenberg LN, Maffini MV, Sonnenschein C, Rubin BS, Soto AM. 2009. Bisphenol-A and the
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2. Calafat AM, Kuklenyik Z, Reidy JA, Caudill SP, Ekong J, Needham LL. 2005. Urinary
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bisphenol A and 4-tertiary-octylphenol: 2003–2004. Environ Health Perspect 116:39–44.
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4. Moriyama K, Tagami T, Akamizu T, Usui T, Saijo M, Kanamoto N, Hataya Y, Shimatsu A, Kuzuya
H, Nakao K. 2002. Thyroid hormone action is disrupted by bisphenol A as an antagonist. J Clin
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Figures and Tables
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7. Relationship between Urinary Bisphenol A Levels and Diabetes Mellitus
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232607/?report=printable
Table 1.
Baseline characteristics of the study population by gender
Characteristics
Men
Women
1879
2088
44.3 ± 0.5
45.6 ± 0.4
Non-Hispanic whites
953 (71.5)
991 (70.0)
Non-Hispanic blacks
373 (9.7)
425 (11.5)
Mexican-Americans
351 (8.5)
436 (8.0)
202 (10.2)
236 (10.4)
Below high school
511 (17.9)
560 (16.7)
High school
476 (25.5)
510 (24.9)
Above high school
892 (56.6)
1018 (58.4)
Never smoker
840 (45.7)
1289 (58.7)
Former smoker
529 (27.2)
403 (20.3)
Current smoker
510 (27.1)
396 (21.0)
Nondrinker
533 (24.5)
894 (35.7)
Moderate drinker
663 (38.7)
863 (47.3)
Heavy drinker
683 (36.8)
331 (17.0)
Normal weight (<25)
544 (28.6)
695 (40.3)
Overweight (25–30)
726 (38.1)
618 (26.5)
Obese (BMI ≥ 30)
609 (33.3)
775 (33.2)
Systolic blood pressure (mm Hg)
123.1 ± 0.4
119.1 ± 0.5
Diastolic blood pressure (mm Hg)
72.4 ± 0.4
69.2 ± 0.3
n
Age (yr)
Race/ethnicity
Others
Education categories
Smoking
Alcohol intake
BMI (kg/m2)
Urinary creatinine (mg/dl)
147.38 ± 2.63 106.55 ± 2.14
Total cholesterol (mg/dl)
201.55 ± 1.12 202.23 ± 1.03
Urinary BPA (ng/ml)
Diabetes (%)
3.97 ± 0.21
3.90 ± 0.26
229 (9.5)
238 (8.7)
Data are presented as weighted number (percentage) or mean ± SE by gender, as appropriate for the
variable.
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Table 2.
Association between urinary BPA and diabetes mellitus
BPA quartiles
(ng/ml)
Sample size (diabetes Age-, sex-adjusted, OR (95% Multivariable-adjusted, OR (95%
a
%)
CI)
CI)
Quartile 1 (<1.10)
1121 (8.3)
1 (referent)
1 (referent)
Quartile 2 (1.10–2.10)
905 (10.8)
1.55 (1.19–2.02)
1.42 (1.03–1.96)
Quartile 3 (2.11–4.20)
977 (11.2)
1.60 (1.25–2.05)
1.48 (1.05–2.08)
Quartile 4 (>4.20)
964 (12.8)
1.81 (1.36–2.43)
1.68 (1.22–2.30)
<0.0001
0.002
p-trend
a Adjusted for age
(years), gender, race-ethnicity (non-Hispanic whites, non-Hispanic blacks,
Mexican-Americans, others), education categories (below high school, high school, above high
school), smoking (never, former, current), alcohol intake (never, former, current), BMI (normal,
overweight, obese), systolic and diastolic blood pressure (mm Hg), urinary creatinine (mg/dl), and
total cholesterol (mg/dl).
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Table 3.
Association between urinary BPA and diabetes mellitus by BMI
Normal weight
BPA quartiles
Sample
(ng/ml)
Overweight/obese
Sample
size
Multivariable-adjusted, OR
a
(95% CI)
size
Multivariable-adjusted, OR
a
(95% CI)
Quartile 1 (<1.10)
408
1 (referent)
713
1 (referent)
Quartile 2
276
2.75 (1.03–7.33)
629
1.27 (0.90–1.79)
272
2.14 (0.79–5.81)
705
1.41 (1.00–1.98)
283
3.17 (1.23–8.18)
681
1.56 (1.09–2.24)
(1.10–2.10)
Quartile 3
(2.11–4.20)
Quartile 4 (>4.20)
p-trend
0.03
0.01
a
Adjusted for age (years), gender, race-ethnicity (non-Hispanic whites, non-Hispanic blacks,
Mexican-Americans, others), education categories (below high school, high school, above high
school), smoking (never, former, current), alcohol intake (never, former, current), systolic and
diastolic blood pressure (mm Hg), urinary creatinine (mg/dl), and total cholesterol (mg/dl).
Articles from The Journal of Clinical Endocrinology and Metabolism are provided here courtesy of The Endocrine Society
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